| NPI | 1568428266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME20802) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 51965) |
| 208600000X Surgery (Licence: NC 2007-01838) | |
| 208600000X Surgery (Licence: GA 80793) | |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2022-06-24 |